• Korea Journal of Hospital Management
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• v.15 no.4
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• pp.125-142
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• 2010

Objective : To determine demographic, clinical, health care utilization factors predicting unplanned readmission(within 28 days) to the hospital. Methods : A case-control study was conducted from January to December 2009. Multiple logistic regression was used to examine risk factors for readmission. 180 patients who had been readmitted within 28 days and 1,784 controls were recruited from an university hospital in Seoul. Results : Six risk factors associated with readmission risk were identified and include mail sex, medical service rather than surgical service, number of comorbid diseases, type of patient's room, lenth of stay, number of admissions in the prior 12 months. Conclusions : One of the association with readmission risk identified was the number of hospital admissions in the previous year. This factor may be the only risk factor necessary for assessing prior risk and has the additional advantage of being easily accessible from computerized medical records without requiring other medical record review. This risk factor may be useful in identifying a group at high readmission risk, which could be targeted in intervention studies. Multiple risk factors intervention approach should be considered in designing future prevention strategies.

• Journal of Preventive Medicine and Public Health
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• v.52 no.5
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• pp.316-322
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• 2019

Objectives: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. Methods: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. Results: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. Conclusions: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

• Journal of The Korean Association For Science Education
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• v.30 no.4
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• pp.452-471
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• 2010

As the Korean College scholastic Ability Test (CSAT) has been implemented for 17 years since 1994, it is becoming more and more difficult to make new items that haven't been previously used to measure students' thinking ability. Therefore, it is necessary to keep conducting research on making new test items that can measure students' scholastic ability reliably. For this reason, multiple choice items on the Japanese university entrance exam, which is a Japanese National Center Test for University Admissions (NCTUA) equivalent of CSAT, were analyzed in order to draw implications for CSAT item development. In this study, we analyzed the Japanese NCTUA administered in January 2009 to investigate the structure of its science test. We also analyzed the NCTUA items by the domains of contents and behaviors, and tried to predict item difficulty from the perspective of Korean applicants. Major findings are as follows: Most NCTUA items measure understanding knowledge or low level thinking ability. Also the alloted time for each item is longer than CSAT. The number of test items, and the number of choice and alloted points for each item are diverse, unlike CSAT. The number of items using real-life materials are much more, but the items are not rigorous in sentence expression compared to CSAT. And the difference of difficulty level among science tests were larger with reference to CSAT. Also science score is required for most applicants regardless whether they are taking liberal arts or going onto the science track.

• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.170-181
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• 2011

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.58-67
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• 1995

Background: This paper describes an effort to provide baseline informations for appropriate utilization of emergency room in a tertiary hospital. Methods: Authors have evaluated that the admissions in the emergency room were medically necessary by objective criteria, Appropriateness Evaluation Protocol(AEP), for one month in a tertiary hospital. Data were analysed by chi-square test and multiple logistic regression to exmaine statistical significances at the level of 0.05. Results: The prevalence of inappropriate decisions for admission was found to be 47.8%(154/322). Whether the physician decided the patient to admit or not was affected by type of services, number of departments involved, patients' medical condition, route of visit, and a day of the week visited. Level of appropriateness of admission is significantly related to patients' age, type of services, and a day of the week visited. Conclusion: We found that substantial proportion of admissions through emergency room are medically unnecessary and that non-medical factors are related to physician's for admission decisions and level of appropriateness of admission. This suggests that policy measures be required to relieve the overcrowding problem and to reduce non-emergent utilization of emergency room in a tertiary hospital.

• Tuberculosis and Respiratory Diseases
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• v.70 no.5
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• pp.416-422
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• 2011

Background: Inhaled corticosteroids (ICSs) are the most essential medication for asthma control. Many reports suggest that the usage of ICSs improves not only the control of asthma symptoms but also prevents exacerbation. We investigated whether increases in ICS prescriptions are associated with decreases in asthma exacerbation in the clinical practice setting. Methods: We retrospectively analyzed the database of adult asthma patients who had visited a tertiary referral hospital, the Asan Medical Center between January 2000 and December 2009. The number of emergency department (ED) visits, admissions, intensive care unit (ICU) care, deaths, and ICS prescriptions were analyzed to evaluate the time trend of asthma exacerbation as a function of the ICS prescription rate during the ten years. Results: The numbers of ED visits, admissions, and episodes of ICU care decreased during the ten years (p<0.001, p=0.033, p=0.001, respectively) while the number of ICS prescriptions increased (p<0.001). We found a correlation between the number of ICS prescriptions and the number of ED visits, admissions, or ICU care. For these outcomes, the correlation coefficients were r=-0.952, p<0.001; r=-0.673, p=0.033; r=-0.948, p<0.001, respectively. Conclusion: The number of ICS prescriptions increased during the past ten years while the number of asthma exacerbations decreased. Our results also showed a negative correlation between the ICS prescription rate and asthma exacerbation in the clinical practice setting. In other words, an increase in ICS prescription may be a major cause of a decrease in asthma exacerbations.

• Health Policy and Management
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• v.29 no.4
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• pp.513-522
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• 2019

Background: South Korea operates a Medical Aid (MA) program targeting selected low-income individuals to ensure medical service delivery to the disadvantaged while enhancing self-sufficiency of work-capable beneficiaries. However, as reasons behind welfare exits are diverse and do not always infer poverty relief or the provision of appropriate levels of health care services, this study aimed to investigate the association between changes in MA status and health care utilization. Methods: This study used the 2006 to 2015 National Health Insurance claims data. The impact of changes in annual MA status on health care utilization (yearly number of outpatient visits, inpatient visits, length of stay, and emergency department [ED] visits) was investigated using the generalized estimating equation model. Results: In 117,943 adult subjects aged 20 to 64, compared to the 'MA to MA' group, the 'MA to MA exit' group showed general decreases in utilization (outpatient visits: β=-3.93, p<0.0001; hospital admissions: relative risk [RR], 0.87; 95% confidence interval [CI], 0.83-0.91; length of stay: β=-3.64, p<0.0001; ED visits: RR, 0.83; 95% CI, 0.77-0.90). Similar patterns were found in the 'MA exit to MA exit' group (outpatient visits: β=-5.72, p<0.0001; admissions: RR, 0.91; 95% CI, 0.87-0.94; length of stay: β=-5.87; p<0.0001; ED visits: RR, 0.81; 95% CI, 0.75-0.88). Likewise, in 74,747 older adult subjects aged 65 or above, the 'MA to MA exit' group showed reduced levels of utilization (outpatient visits: β=-1.51; p=0.0020), as well as the 'MA exit to MA exit' group (admissions: RR, 0.92; 95% CI, 0.89-0.95; length of stay: β, -5.45; p<0.0001; ED visits: RR, 0.90; 95% CI, 0.83-0.97). Conclusion: MA exit was associated with general decreases in health care utilization. Utilization patterns of individuals with experiences of receiving MA benefits should be monitored to promote the ideal use of health care services while preventing potential financial barriers present in accessing medical care.

• Annual Conference of KIPS
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• 2012.11a
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• pp.343-346
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• 2012

There are many realistic system necessities on the huge size of rule matrices with any Fuzzy Logical Inferences. This paper indicates the experimental design policy on the PCS design for the Platoon and AOS for the social application with some identical resemblances in between them so that we could use a design for two different usages feasibly.

• Proceedings of the PSK Conference
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• 2003.10b
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• pp.249.2-250
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• 2003

${\beta}$-blockers are considered as standard therapy for patients with stable chronic heart failure (CHF) and to prolong survival and reduce hospitalizations. We examined the effects of the ${\beta}$-blocker on mortality, hospitalization and symptoms in patients with CHF and the related factors to the use of ${\beta}$-blockers. Patients in New York Heart Association class II-IV were included if they were treated for heart failure from January 2002 to June 2002. At baseline, 6 months, and 12 months, they were assessed for the change of NYHA class and all deaths and hospital admissions. (omitted)

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.1
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• pp.16-24
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• 2008

Purpose: There has been no nationwide surveillance survey of poisoning cases in Korea. This study examined the clinical characteristics of poisoning admissions in order to obtain preliminary data for future planning. Methods: This study retrospectively reviewed the data on poisoning admissions of 150 hospitals based on the hospital discharge injury surveillance data of Center for Disease Control and Prevention in Korea from January to December in 2004. The demographic data, poisons used, causes of poisoning, reasons for attempted suicide and mortality rate was investigated according to the age group. The factors associated with mortality were also evaluated. Results: A total 836 patients admitted for poisoning were analyzed. Their mean age was $46.5{\pm}19.5$ years (male 415, female 421). The most frequent age group was the 4th and 5th decades. The most common poisons involved were pesticides (45%) and medications (23%). The majority (64%) involved intentional poisoning except for those in the 1st decade. The most common reason for the attempted suicide was family problems. However, individual disease was the most common reason in those over 60 years. The overall mortality rate was 8.7% (73/836). Pesticides and being elderly (over 65 years old) were strongly correlated with fatality. Conclusion: The incidence of intentional poisoning increases from the 2nd decade making it a preventable injury. "Overall, the incidence of intentional poisoning increases from the 2nd decade". Therefore, there is a need to frame a prevention policy corresponding to each factor related to fatality, such as an elderly population and pesticides.